What Factors Affect the Prognosis of Uterine Cancer?

Usually called uterine cancer actually refers to endometrial cancer, also known as uterine cancer, which occurs in the endometrial epithelium, most of which are adenocarcinoma. It is a common cancer in the female reproductive system. Its incidence is second only to cervical cancer, and it ranks fourth among the most common cancers in women. More common in women aged 50 to 60 years, often occurs after menopause. In recent years, the incidence has been increasing worldwide. It can be transferred to many parts of the body: from the uterus down to the cervical canal, from the fallopian tube up to the ovaries; it can also infiltrate the tissues around the uterus; or through the lymphatic system and blood circulation to areas far from the uterus.

Basic Information

nickname

Endometrial cancer

English name

endometrial carcinoma

Visiting department

Obstetrics and Gynecology

Multiple groups

50 to 60 year old women

Common causes

Sexual partners, perimenopause, sexually transmitted diseases, cervicitis, etc. are prone to cause

Common symptoms

Early asymptomatic, followed by vaginal bleeding, drainage, pain, etc.

Causes of uterine cancer

Women with early marriage, early childbearing, fertility, infertility, infertility, premature menarche, delayed menopause and sexual disturbances have a higher prevalence. At present, it is also believed that cholesterol in foreskin can be transformed into carcinogens by bacterial action. It is also an important cause of cervical cancer. Possible causes of uterine cancer are:

Sex life

If women have more than two male partners, the risk of uterine cancer is significantly increased.

2. age

The vast majority of endometrial cancer patients are perimenopausal, with only 15% of women diagnosed with endometrial cancer before the age of 50 and only 5% of women.

3. STD infection

Sexually transmitted infections usually have a more complex life, and their relative risk of developing uterine cancer is also higher.

4. Inflammation of the cervix

If there is long-term cervical damage, skin peeling, erosion, and inflammation, it may turn into early uterine cancer cells.

5. Smoking

Smoking will increase the chance of developing type 2 endometrial cancer: first, smoking will reduce the body's immunity and accelerate the development of uterine cancer cells;

6. Female hormones

Whether it is endogenous or exogenous estrogen, long-term effects of estrogen without antagonistic progestin are related to the occurrence of type I endometrial cancer. The large-scale use of selective estrogen receptor modulators has played an estrogen receptor agonist in endometrial tissues to varying degrees. Although the use of tamoxifen reduces the risk of breast cancer and its recurrence, it increases the risk of endometrial cancer. Some scholars believe that progesterone can change the stability of cervical epithelial cells, and is prone to abnormal changes, which may lead to the development of uterine cancer cells.

Clinical manifestations of uterine cancer

Symptoms

There are no obvious symptoms in the very early stage, and later vaginal bleeding, vaginal drainage, pain and so on.

(1 ) Vaginal bleeding is mainly manifested by irregular menstrual cycles and intermenstrual bleeding, and vaginal bleeding after menopause. The amount is generally small. Those who have not yet reached menopause may show increased menstruation, prolonged periods, or menstrual disorders.

(2 ) The vaginal drainage is mostly bloody or serous secretions, and the combined infection has purulent drainage and foul odor. About 25% of the patients visited because of abnormal vaginal drainage.

(3 ) Pain in the lower abdomen and others If the cancer invades the uterine cavity, it can cause pus in the uterine cavity, causing abdominal pain and spastic pain. Late infiltration of surrounding tissues or compression of nerves can cause pain in the lower abdomen and lumbar spinal cord. Corresponding symptoms such as anemia, weight loss and cachexia may occur in the later stage.

2. Signs

Gynecological examination of early endometrial cancer can be found without abnormality. In the later stage, there may be a significant increase in the uterus, and there may be obvious tenderness when the uterine cavity is purulent. Occasionally, cancerous tissue in the cervical canal comes out, and bleeding is easy to touch. When the cancerous lesion infiltrates the surrounding tissue, the uterus is fixed or irregular nodules are touched by the uterus.

Uterine cancer test

1. Medical history and clinical manifestations

For postmenopausal vaginal bleeding and menstrual disorders during the menopausal transition period, endometrial cancer should be ruled out before being treated as a benign disease. Women should follow up closely with:

(1) Those with high risk factors for endometrial cancer, such as obesity, infertility, and delayed menopause;

(2) People with a history of long-term use of estrogen, tamoxifen or estrogen;

(3) Those with a family history of breast cancer and endometrial cancer. If necessary, perform segmental diagnosis and scrape histopathology.

2.B ultrasound examination, pelvic MRI examination

You can understand the size of the uterus, the shape of the uterine cavity, the presence of neoplasm in the uterine cavity, the thickness of the endometrium, and the infiltration and depth of the muscular layer, which can provide a reference for clinical diagnosis and treatment. MRI can better evaluate the status of pelvic lymph nodes. The American College of Obstetricians and Gynecologists (ACOG) guidelines do not require routine imaging studies of endometrial cancer patients to assess the presence of metastases.

3. Segmented curettage

Is the most commonly used and most valuable histological assessment of the preferred diagnostic method of endometrium. The advantage of segmented diagnosis and curettage is that it can obtain endometrial tissue specimens for pathological diagnosis, and it can also identify endometrial cancer and cervical adenoma; it can also determine whether endometrial cancer affects the cervical canal and provide a treatment plan for the treatment. in accordance with. Endometrial biopsy with disposable instruments in the clinic is a reliable and accurate method for endometrial cancer detection. Hysteroscopy, although not required, is still recommended in conjunction with diagnostic curettage to identify discontinuous lesions and concealed lesions. This combined examination can provide the best opportunity for the diagnosis of true endometrial precancerous lesions, and can exclude related endometrial cancer. For persistent or recurrent abnormal uterine bleeding, regardless of endometrial thickness, a histological assessment of the endometrium should be performed.

Uterine cancer diagnosis

In addition to clinical manifestations and signs, pathological histological examination is the basis for confirming the diagnosis.

Uterine Cancer Treatment

The main treatment methods are surgical radiotherapy and drugs (chemical drugs and hormones). The appropriate treatment plan should be selected and formulated according to the patient's general condition, the extent of cancerous involvement and the type of histology. Early patients are mainly operated by surgery and staged by surgery-pathology The results and the existing high-risk factors of recurrence were selected as adjuvant treatment; in the later stage, comprehensive treatment such as surgery, radiation and drugs were used.

Surgical treatment

Is the preferred treatment. The first purpose of the operation is to perform surgery and pathological staging to determine the extent of the lesion and important factors related to prognosis; the second is to remove the cancerous uterus and other metastatic lesions that may exist. During the operation, a comprehensive exploration is performed first, and samples of suspicious lesions are taken for frozen section examination; ascites or pelvic lavage fluid is left for cytological examination. The resected uterine specimens were dissected to determine the presence of myometrial infiltration. Surgical specimens should be routinely examined for pathology, and cancer tissues should also be tested for estrogen and progesterone receptors as a basis for selecting adjuvant therapy after surgery. Patients with stage I should undergo extrafascial hysterectomy and bilateral appendectomy. Those with one of the following conditions should undergo pelvic and paraabdominal lymphadenectomy or sampling; special pathological types such as papillary serous adenocarcinoma, clear cell carcinoma, squamous cell carcinoma, undifferentiated carcinoma, etc .; endometrioid glands Cancer G3; myometrial invasion depth; cancer lesions involving more than 50% of the uterine cavity area or isthmus involvement. In view of the high malignancy of endometrial papillary serous carcinoma and the characteristics of early lymphatic metastasis and pelvic and abdominal metastasis, the scope of clinical stage I surgery should be the same as that of ovarian cancer, except for the staged exploration and removal of the uterus and the double appendages to clean the retroperitoneal lymph nodes The omentum and appendix should be removed. Stage II should be performed with a full or extensive hysterectomy and double appendectomy, with pelvic and paraaortic lymphadenectomy. The scope of surgery for patients with advanced stage III and IV is also the same as that of ovarian cancer, and tumor cytoreductive surgery should be performed. Transvaginal hysterectomy is a good choice for patients with early endometrial cancer who have high-risk surgical complications.

2. Radiotherapy

It is the main postoperative adjuvant treatment for endometrial cancer, which can significantly reduce local recurrence and improve survival rate. Patients who have deep muscle invasion, lymph node metastasis, and residual pelvic and vaginal lesions need to be treated with radiotherapy.

3. Progestin therapy

Mainly used for the treatment of advanced or recurrent endometrial cancer. For patients with advanced or relapsed endometrial cancer, hormone therapy can be selected if they are unable or unwilling to receive more aggressive treatment, regardless of tumor grade or hormone receptor status. For young patients eager to retain fertility and patients who cannot tolerate surgery, progestin therapy is the main conservative treatment.

4. Treatment with anti-estrogens

The indication is the same as the progestin.

5. Chemotherapy

It is one of the comprehensive treatment measures for advanced or relapsed endometrial cancer; it can also be used in the treatment of patients with high risk factors for recurrence after surgery to reduce distant metastasis outside the pelvis, and chemotherapy can improve its prognosis. Commonly used chemotherapeutic drugs are cisplatin, doxorubicin, paclitaxel, cyclophosphamide, fluorouracil, mitomycin, etopoxil and the like. Can be used alone or in combination, or combined with progestin. Uterine papillary serous adenocarcinoma should be given chemotherapy after surgery, the same as the ovarian epithelial cancer. It is reported in the literature that for patients with advanced lesions, paclitaxel + carboplatin chemotherapy is similar to other chemotherapy regimens and relatively less toxic. The combination of chemotherapy and radiation therapy for patients with advanced endometrial cancer can improve the patient's prognosis better than a single treatment.

Uterine cancer prevention

Popularize anti-cancer knowledge and regular physical examination; attach importance to the diagnosis and treatment of postmenopausal women's vaginal bleeding and perimenopausal women's menstrual disorders; correctly grasp the indications and methods of estrogen application; people with high risk factors should be closely followed or monitored.